Provider Demographics
NPI:1366796427
Name:OKONIAK-WHITE, MARZENA MARIANNA
Entity type:Individual
Prefix:MRS
First Name:MARZENA
Middle Name:MARIANNA
Last Name:OKONIAK-WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 WINDSTAR BLVD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-7379
Mailing Address - Country:US
Mailing Address - Phone:317-560-9022
Mailing Address - Fax:
Practice Address - Street 1:1070 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2179
Practice Address - Country:US
Practice Address - Phone:317-736-1119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-28
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001752A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant